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Mechanical Complications of Central Venous Catheters

Beth Israel Medical Center, Pulmonary Division, 7 Dazian, 17th Street at 1st Avenue, NY, NY 10010; leisen{at}gmail.com

Mangala Narasimhan, DO

Division of Pulmonary and Critical Care, Beth Israel Medical Center, New York, New York

Jeffrey S. Berger, MD

Department of Internal Medicine, Beth Israel Medical Center, New York, New York

Paul H. Mayo, MD

Mark J. Rosen, MD

Division of Pulmonary and Critical Care, Beth Israel Medical Center, New York, New York

Roslyn F. Schneider, MD

Department of Internal Medicine, Beth Israel Medical Center, New York, New York

We analyzed 385 consecutive central venous catheter (CVC) attempts over a 6-month period. All critically ill patients 18 years of age or older requiring a CVC were included. The rate of mechanical complications not including failure to place was 14%. Complications included failure to place the CVC (n = 86), arterial puncture (n = 18), improper position (n = 14), pneumothorax (n = 5 in 258 subclavian and internal jugular attempts), hematoma (n = 3), hemothorax (n = 1), and asystolic cardiac arrest of unknown etiology (n = 1). Male patients had a significantly higher complication rate than female patients (37% vs 27%, P = .04). The subclavian approach had a higher complication rate than the internal jugular or the femoral approach (39% vs 33% vs. 24%, P = .02). The complication rate increased with the number of percutaneous punctures, with a rate of 54% when more than 2 punctures were required.

Key Words: central venous catheterization • complications • critical care • pneumothorax • education

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